Pain Reliever

If you suffer from chronic pain, working out may be the last thing you feel like doing. But exercise can make you feel better – now, and over the long term.

When Jen Saunders was a junior in high school, she was diagnosed with chondromalacia patella — a degenerative condition that is a precursor to osteoarthritis — in both knees. Although she was an accomplished athlete and intended to play sports in college, doctors said her exercise options would be extremely limited. So Saunders gave up all athletic pursuits, with the exception of a little swimming.

By the time she turned 23, the pain, which by then had moved into her lower back because of gait compensations, was debilitating. “My pain was often a seven out of 10, and there were days it was difficult to walk up a flight of stairs,” says Saunders, now 29, who lives in New York City.

But Saunders missed exercising so much that, in 2003, she decided to give it another try. “I’d read about the benefits of Pilates and hoped it wouldn’t hurt my knees,” she says. She began doing DVD workouts several times a week and, within a month, was surprised to discover she felt less pain. Why? Pilates strengthened her core muscles and the muscles around her knees, taking pressure off her aching joints.

Encouraged, Saunders started participating in other activities — and experienced such dramatic improvement that, several months later, she even began running short distances. She now exercises four to six days a week. She’s completed two sprint-distance triathlons, and she’s making plans to race bikes. She still suffers from some pain, but her exercise routine has changed her life. “Even though it sounds counterintuitive that exercise will lessen chronic pain,” she says, “it really does make a difference.”

If you’re a chronic pain sufferer like Saunders, just thinking about moving might make your body hurt. Yet studies have shown that exercise can help manage painful conditions like arthritis, chronic fatigue syndrome, fibromyalgia, chronic back or neck pain, and myofascial pain syndrome.

“Though it may not completely eliminate pain, exercise improves your ability to function,” says Kathleen Sluka, PT, PhD, professor of physical therapy and rehab sciences at the University of Iowa in Iowa City.

Your workout doesn’t need to be intense to net you relief. A 2007 study presented at the American Pain Society’s annual meeting found some pain-relieving benefits from even low-intensity exercise.

Feeling a little more motivated to move? Here are the mechanics behind the magic:

Exercise releases feel-good hormones. “When you exercise, your body releases endorphins and other pain-modifying chemicals and hormones,” says Edward Laskowski, MD, physical medicine and rehabilitation specialist and codirector of the Sports Medicine Center at the Mayo Clinic in Rochester, Minn. These substances appear to override pain receptors in the brain and keep fatigue at bay.

Exercise reduces bodywide inflammation. A poor diet and sedentary lifestyle can contribute to chronic inflammation (measured by C-reactive protein, or CRP, in the blood). As a result, the body can turn on itself, attacking everything from cartilage in the joints to cells in the brain, causing pain and discomfort. Studies show that a regular, moderate exercise program can dramatically reduce levels of CRP. (Check out “Fighting Inflammation” in the July/August 2004 archives.)

Exercise, done right, corrects muscle imbalances. A well-balanced exercise program can correct lifestyle-induced postural problems that cause pain. Too much sitting, for instance, causes hip flexors and chest muscles to become shorter and tighter than their opposing muscle groups: the glutes and the upper back, says Mitchell T. Yass, PT, author of Overpower Pain: The Strength-Training Program That Stops Pain without Drugs or Surgery (Sentient Publications, 2008) and founder of PT2 Physical Therapy and Personal Training in Farmingdale, N.Y. “When a muscle is weaker than its opposing muscle, the joint [it] attaches to is pulled out of position, potentially causing pain and loss of function,” he explains. “The altered length of the muscles will also affect their ability to create force, making them susceptible to straining.”

Muscle imbalances can be corrected by strengthening the weak muscles and stretching the tight ones. (For specific exercises, see “Office Imbalance” in the March 2007 archives.)

Exercise lubricates joints. Healthy joints are lubricated with plenty of synovial fluid — enough to allow smooth and pain-free movement. But people suffering from conditions like osteoarthritis produce less synovial fluid. Exercise not only increases the fluid production, but by strengthening muscles around the joint, you offload some of the pressure on the joint itself.

Keep in mind that chronic pain can originate from many sources, and not all of them will respond the same way to exercise. So once you figure out what’s causing your pain, work with a pain-management specialist — perhaps a chiropractor, physical therapist or sports-medicine specialist — who understands your condition and can tailor an
exercise program to your needs.

Baby Steps

Exercise can make a dramatic difference in the way you feel, but don’t expect to see immediate results. “You may even feel a little more pain immediately after exercising — especially with chronic fatigue syndrome and fibromyalgia — but if you make exercise a habit, that postworkout pain will diminish,” Sluka says. Feeling some pain 30 minutes after you exercise may be expected, she adds, but you’ve probably overdone it if you’re still feeling pain two hours after exercising. If that happens, decrease the intensity and duration of your next workout.

If you’re having trouble getting started on a program, consider working with a psychologist who specializes in cognitive behavioral therapy. “You’ll work on turning negative thoughts into positive ones and setting small behavioral goals that will ultimately lead to regular participation in exercise,” says John D. Otis, PhD, assistant professor of psychology at Boston University and author of Managing Chronic Pain(Oxford University Press, 2007). For instance, if you’ve been advised to start a walking program, your first goal might simply be to walk around the block.

And who knows — that walk around the block may lead to more. Because, while exercise can’t always cure chronic pain, the right program can be awfully strong medicine.

Seeking Relief

What type of exercise works best for different conditions? Specifics vary by individual, of course, but here are some general rules of thumb.

Back pain: Aerobic conditioning and core-strengthening exercises are often most effective, says Kathleen Sluka, PT, PhD, professor of physical therapy and rehab sciences at the University of Iowa in Iowa City. Aerobic exercise releases endogenous opioids and activates central inhibitory mechanisms in the brain, both of which work directly and indirectly to inhibit pain. Meanwhile, core strength improves spinal stability, something those with back pain often lack.

Fibromyalgia or chronic fatigue syndrome: Experts suggest a general aerobic conditioning program that includes low-impact activities such as swimming and walking. Again, aerobic exercise releases opioids, activates central inhibitory mechanisms and increases endurance. Resistance training helps develop healthier, more pliable muscles — as do activities such as yoga and tai chi.

Osteoarthritis or rheumatoid arthritis: A strength program — one targeted to specific muscles around joints — may be best suited for people with osteoarthritis or rheumatoid arthritis. By increasing strength and stability around the joint, you relieve stress on joint structures.

Myofascial syndrome: This condition usually responds best to stretching and active strengthening exercises. These activities improve range of motion, increase muscle strength, and reduce stress on trigger points and adhesions on muscle sheaths.

Web Extra: How to Work Out With Pain

Although exercise can certainly help alleviate pain, you want to make sure you’re doing it safely. Here are basic guidelines you should follow:Seek specialized help: There’s no one-size-fits-all exercise program for chronic pain sufferers, which is why you need to work with someone who specializes in designing exercise programs for your condition.

Avoid the terrible “too”s: Too much, too hard, too fast and too long. Although you might have good intentions, overdoing exercise when you’re just starting out can increase pain, says Edward Laskowski, MD, physical medicine and rehabilitation specialist and codirector of the Sports Medicine Center at the Mayo Clinic in Rochester, Minn. A little pain after exercising might be expected, but if you’re still feeling pain hours later, you’ve overdone it. Start slowly and progress gradually.

Stay hydrated: Not only does your body need to replace lost water from sweating, but water also helps keep your joints lubricated, making movement easier, says Steven Shoshany, DC, CCEP, chiropractor and spinal decompression specialist in New York City.

Allow time to warm up: Warming up increases core body temperature and makes muscles more pliable, which will help you avoid injury. A good warm-up should last about five to 10 minutes. (See “Gradual Is Good” in the March 2007 archives.)

Commit to exercise for the long haul: Once their pain dissipates, people often stop exercising, says Kathleen Sluka, PT, PhD, professor of physical therapy and rehab sciences at the University of Iowa in Iowa City. This is a major mistake, as pain can return if you become inactive. Instead, view exercise as a lifetime commitment and choose activities you enjoy.

Reward small successes: Feeling successful is critical to sticking with an exercise plan, says John D. Otis, PhD, a licensed clinical psychologist in Newton, Mass., and author of Managing Chronic Pain (Oxford University Press, 2007). Set small goals and reward yourself when you meet those goals.